家庭医生签约高脂血症患者的血脂管理现状及影响因素分析

Status quo and influencing factors of hyperlipidemia management in patients with contracted family doctor service

目的了解签约家庭医生服务的高脂血症患者血脂管理现状及其影响因素,为进一步制定血脂管理方案提供理论依据。方法本研究采用横断面调查,纳入2019年11月至2020年5月就诊于北京市月坛社区卫生服务中心及下属站并行生化检查的高脂血症患者,均已签约家庭医生服务,收集其基线资料及血脂指标,比较不同特征患者的动脉粥样硬化性心血管疾病(ASCVD)危险分层分布、低密度脂蛋白胆固醇(LDL-C)达标率,采用logistic回归分析LDL-C不达标的影响因素。结果共收集病例752例,其中男性334例,女性418例。ASCVD风险评估结果显示低危、中危、高危、极高危比例分别为22.87%(172/765)、22.21%(167/752)、46.81%(352/752)、8.11%(61/752)。ASCVD危险分层在性别、是否吸烟、是否超重或肥胖中的分布差异有统计学意义(P<0.05)。LDL-C总体达标率为48.80%(367/752),其中低危、中危、高危、极高危达标率分别为83.73%(144/172)、53.89%(90/167)、34.38%(121/352)、19.67%(12/61)。女性(52.87%,221/418)、年龄≥80岁(58.82%,110/187)、不吸烟(52.40%,327/624)、规律用药(52.87%,221/418)的患者达标率更高(χ2值分别为6.323、11.816、19.022、25.274,P<0.05)。多因素logistic回归分析显示,男性(OR=1.800,95%CI:1.325~2.419)、吸烟(OR=2.630,95%CI:1.726~4.007)、不规律/自行停药(OR=2.179,95%CI:1.581~3.003)是影响患者LDL-C达标的独立危险因素。结论家庭医生签约的高脂血症患者心血管病风险较高,血脂控制尚不满意,应加强患者尤其是男性、吸烟、不规律用药患者的血脂管理。

Objective To evaluate the status quo and influencing factors of hyperlipidemia management in patients with contracted family doctor service in the community.Method The baseline data and blood lipid testing results of 752 hyperlipidemia patients(334 males and 418 females)with contracted family doctor service in Yuetan Community Health Service Center from November 2019 to May 2020 were collected.The hyperlipidemic patients were managed by family doctors based on atherosclerotic cardiovascular diseases(ASCVD)riks assessment.The ASCVD risk levels and low-density lipoprotein cholesterol(LDL-C)compliance rate of patients with different general data were compared,and the influencing factors of LDL-C control failure were analyzed by logistic regression.Results The ASCVD risk assessment showed that among 752 patients there were 172 cases of low risk(22.87%),167 cases of moderate risk(22.21%),352 cases of high risk(46.81%)and 61 cases of extremely high risk(8.11%).A significant difference was detected in sex,rate of smoking,incidence of overweight or obesity among patients with different ASCVD risk levels(P<0.05).The overall control rate of LDL-C was 48.8%(367/752),that for low,moderate,high and extremely high risk patients were 83.73%(144/172),53.89%(90/167),34.38%(121/352)and 19.67%(12/61),respectively.A significant difference was detected in sex(female:52.87%,221/418),age(aged over 80:58.82%,110/187),rate of smoking(non-smoking:52.40%,327/624)and medication compliance(good compliance:52.87%,221/418)between LDL-C control and uncontrol groups(χ^(2)=6.323,11.816,19.022,25.274;P<0.05).Multiple logistic regression analysis revealed that male gender(OR=1.800,95%CI:1.325-2.419),smoking(OR=2.630,95%CI:1.726-4.007)and poor medication compliance(OR=2.179,95%CI:1.581-3.003)were independent risk factors for uncontrolled LDL-C levels.Conclusion Patients with hyperlipidemia have a relatively high risk of cardiovascular diseases,and their blood lipids are not well controlled.The management of blood lipid should be enhanced in patients with chronic diseases,particularly for male patients with smoking and poor medication compliance.